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Combination High Dose Melphalan and Autologous Peripheral Blood Stem Cell (PBSC) Transplant With Bortezomib for Multiple Myeloma: A Dose and Schedule Finding Study

Primary Purpose

Cancer, Multiple Myeloma

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Bortezomib
Melphalan
Autologous PBSC Transplant
Sponsored by
Emory University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cancer focused on measuring Cancer, Multiple Myeloma, Peripheral Blood Stem Cell Transplant

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients with multiple myeloma who are eligible for an autologous peripheral blood progenitor transplant
  • Male and female subjects between the age of 18 and 70 years.
  • Patient has given informed consent prior to any study related procedures with the knowledge that consent can be withdrawn at anytime without prejudice to future medical care
  • Patient is, in the investigator's opinion, willing and able to comply with the protocol requirements
  • Female subject is either post-menopausal or surgically sterilized or willing to use an acceptable method of birth control (i.e., a hormonal contraceptive, intra-uterine device, diaphragm with spermicide, condom with spermicide, or abstinence) for the duration of the study.
  • Male subjects agrees to use an acceptable method for contraception for the duration of the study.
  • Biopsy proven diagnosis of multiple myeloma from bone marrow aspirate and biopsy prior to study initiation
  • Patient has achieved less than 90% disease reduction from previous treatment prior to transplant (as measured by serum or urine protein electrophoresis) and has more than 5% plasma cells in the bone marrow, or patient has progressed and has more than 5% plasma cells in the bone marrow.
  • Karnofsky Performance Status score of ≥ 60%
  • Patient has met the following laboratory requirements prior to Day -4
  • Platelet count ≥ 50, 000/mm3
  • Absolute Neutrophil Count ≥ 500/mm3
  • Hemoglobin ≥ 10 g/dL (transfusion allowed to meet this criterion)
  • Calculated creatinine clearance ≥ 30mL/min
  • Toxic effects of previous therapy or surgery resolved to Grade 2 or better

Exclusion Criteria:

  • Unsupportable anemia with < 10b/dL
  • Patient has a calculated or measured creatinine clearance of < 30mL/min within 14 days before enrollment
  • Patient has ≥ Grade 2 peripheral neuropathy within 14 days before enrollment
  • Patient has hypersensitivity to bortezomib, boron or mannitol
  • Patient has had an allergic reaction to melphalan or chlorambucil
  • Female subject is pregnant or breast-feeding. Confirmation that the subject is not pregnant must be established by a negative serum β-human chorionic gonadotropin (β-hCG) pregnancy test result obtained during screening. Pregnancy testing is not required for post-menopausal or surgically sterilized women.
  • Patient has received other investigational drugs with 14 days before enrollment
  • Serious medical or psychiatric illness likely to interfere with participation in this clinical study
  • Cardiac or pulmonary dysfunction such that patients do not meet institutional pre-transplant evaluation criteria
  • Known central nervous system involvement or suspicion of involvement with Myeloma
  • Other active malignancies (with the exception of basal and squamous cell skin cancer) within 5 years of study entry. Patients with treated prostate or cervical cancer in situ who are 2 or more years from therapy and remain free of disease may be entered into the study at the investigator's discretion.
  • Known to be HIV positive, HIV-1 positive

Sites / Locations

  • Emory University Winship Cancer Institute

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Bortezomib before Melphalan

Bortezomib after Melphalan

Arm Description

Enrolled patients were randomized to receive a single escalating dose of bortezomib (1.0, 1.3, or 1.6 mg/m2) 24 hours before melphalan.

Enrolled patients were randomized to receive a single escalating dose of bortezomib (1.0, 1.3, or 1.6 mg/m2) 24 hours after melphalan.

Outcomes

Primary Outcome Measures

Safety and Engraftment
Peripheral blood progenitor cells were collected with either chemo-mobilization (27 of 39, 69%) or growth factor mobilization (12 of 39, 31%). Patients received an average of 9.0 × 10^6/kg CD34+ cells (range, 2.3-65) as their transplant graft.

Secondary Outcome Measures

Response Rate Using EBMT(European Group for Blood and Bone Marrow Transplan) Criteria at Day +100 After Transplant.
CR :Negative immunofixation on the serum and urine and Disappearance of any soft tissue plasmacytomas and <=5% plasma cells in bone marrow. VGPR: Serum and urine M-protein detectable by immunofixation but not on electrophoresis or 90% or greater reduction in serum M-protein plus urine M-protein level <100mg per 24 hour. Partial Response:>=50% reduction of serum M-protein and reduction in 24-hour urinary M-protein by >=90% or to <200mg per 24 hour.

Full Information

First Posted
November 17, 2008
Last Updated
August 17, 2012
Sponsor
Emory University
Collaborators
Millennium Pharmaceuticals, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT00793650
Brief Title
Combination High Dose Melphalan and Autologous Peripheral Blood Stem Cell (PBSC) Transplant With Bortezomib for Multiple Myeloma: A Dose and Schedule Finding Study
Official Title
Combination High Dose Melphalan and Autologous PBSC Transplant With Bortezomib for Multiple Myeloma: A Dose and Schedule Finding Study
Study Type
Interventional

2. Study Status

Record Verification Date
August 2012
Overall Recruitment Status
Terminated
Study Start Date
May 2005 (undefined)
Primary Completion Date
October 2009 (Actual)
Study Completion Date
September 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Emory University
Collaborators
Millennium Pharmaceuticals, Inc.

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The goal of this study is to evaluate the safety of melphalan and autologous PBSCT (peripheral blood stem cell transplantation - stem cells that come from your own body) in combination with bortezomib, a new FDA approved drug used to treat myeloma.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cancer, Multiple Myeloma
Keywords
Cancer, Multiple Myeloma, Peripheral Blood Stem Cell Transplant

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
39 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Bortezomib before Melphalan
Arm Type
Active Comparator
Arm Description
Enrolled patients were randomized to receive a single escalating dose of bortezomib (1.0, 1.3, or 1.6 mg/m2) 24 hours before melphalan.
Arm Title
Bortezomib after Melphalan
Arm Type
Active Comparator
Arm Description
Enrolled patients were randomized to receive a single escalating dose of bortezomib (1.0, 1.3, or 1.6 mg/m2) 24 hours after melphalan.
Intervention Type
Drug
Intervention Name(s)
Bortezomib
Other Intervention Name(s)
Bortezomib or Velcade
Intervention Description
Escalating doses of bortezomib 1.0, 1.3, or 1.6 mg/m2 in Arm A and Arm B.
Intervention Type
Drug
Intervention Name(s)
Melphalan
Other Intervention Name(s)
Bortezomib or Velcade
Intervention Description
All patients received melphalan (100 mg/m^2/day × 2; days -3 and -2), for a total dose of 200 mg/m^2.
Intervention Type
Procedure
Intervention Name(s)
Autologous PBSC Transplant
Intervention Description
Day 0 consists of the stem cell infusion.
Primary Outcome Measure Information:
Title
Safety and Engraftment
Description
Peripheral blood progenitor cells were collected with either chemo-mobilization (27 of 39, 69%) or growth factor mobilization (12 of 39, 31%). Patients received an average of 9.0 × 10^6/kg CD34+ cells (range, 2.3-65) as their transplant graft.
Time Frame
Day 30 after transplant
Secondary Outcome Measure Information:
Title
Response Rate Using EBMT(European Group for Blood and Bone Marrow Transplan) Criteria at Day +100 After Transplant.
Description
CR :Negative immunofixation on the serum and urine and Disappearance of any soft tissue plasmacytomas and <=5% plasma cells in bone marrow. VGPR: Serum and urine M-protein detectable by immunofixation but not on electrophoresis or 90% or greater reduction in serum M-protein plus urine M-protein level <100mg per 24 hour. Partial Response:>=50% reduction of serum M-protein and reduction in 24-hour urinary M-protein by >=90% or to <200mg per 24 hour.
Time Frame
100 days after transplant

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients with multiple myeloma who are eligible for an autologous peripheral blood progenitor transplant Male and female subjects between the age of 18 and 70 years. Patient has given informed consent prior to any study related procedures with the knowledge that consent can be withdrawn at anytime without prejudice to future medical care Patient is, in the investigator's opinion, willing and able to comply with the protocol requirements Female subject is either post-menopausal or surgically sterilized or willing to use an acceptable method of birth control (i.e., a hormonal contraceptive, intra-uterine device, diaphragm with spermicide, condom with spermicide, or abstinence) for the duration of the study. Male subjects agrees to use an acceptable method for contraception for the duration of the study. Biopsy proven diagnosis of multiple myeloma from bone marrow aspirate and biopsy prior to study initiation Patient has achieved less than 90% disease reduction from previous treatment prior to transplant (as measured by serum or urine protein electrophoresis) and has more than 5% plasma cells in the bone marrow, or patient has progressed and has more than 5% plasma cells in the bone marrow. Karnofsky Performance Status score of ≥ 60% Patient has met the following laboratory requirements prior to Day -4 Platelet count ≥ 50, 000/mm3 Absolute Neutrophil Count ≥ 500/mm3 Hemoglobin ≥ 10 g/dL (transfusion allowed to meet this criterion) Calculated creatinine clearance ≥ 30mL/min Toxic effects of previous therapy or surgery resolved to Grade 2 or better Exclusion Criteria: Unsupportable anemia with < 10b/dL Patient has a calculated or measured creatinine clearance of < 30mL/min within 14 days before enrollment Patient has ≥ Grade 2 peripheral neuropathy within 14 days before enrollment Patient has hypersensitivity to bortezomib, boron or mannitol Patient has had an allergic reaction to melphalan or chlorambucil Female subject is pregnant or breast-feeding. Confirmation that the subject is not pregnant must be established by a negative serum β-human chorionic gonadotropin (β-hCG) pregnancy test result obtained during screening. Pregnancy testing is not required for post-menopausal or surgically sterilized women. Patient has received other investigational drugs with 14 days before enrollment Serious medical or psychiatric illness likely to interfere with participation in this clinical study Cardiac or pulmonary dysfunction such that patients do not meet institutional pre-transplant evaluation criteria Known central nervous system involvement or suspicion of involvement with Myeloma Other active malignancies (with the exception of basal and squamous cell skin cancer) within 5 years of study entry. Patients with treated prostate or cervical cancer in situ who are 2 or more years from therapy and remain free of disease may be entered into the study at the investigator's discretion. Known to be HIV positive, HIV-1 positive
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sagar Lonial, MD
Organizational Affiliation
Emory University Winship Cancer Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Emory University Winship Cancer Institute
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30322
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Combination High Dose Melphalan and Autologous Peripheral Blood Stem Cell (PBSC) Transplant With Bortezomib for Multiple Myeloma: A Dose and Schedule Finding Study

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